HELPING YOU PUT TOGETHER YOUR MEDICARE PUZZLE
MBG IS AN INSURANCE BROKER AND IS NOT ASSOCIATED, ENDORSED, OR AUTHORIZED BY THE SOCIAL SECURITY ADMINISTRATION, THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, OR THE CENTER FOR MEDICARE AND MEDICAID SERVICES (CMS)
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MEDICARE INSURANCE
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Introduction ????
Stelara has emerged as a powerhouse medication in the treatment of psoriasis, psoriatic arthritis, and Crohn’s disease. But the cost can be a considerable hurdle for many. This blog post will explore how Medicare coverage intersects with Stelara to make this transformative treatment more accessible.
What is Stelara? ????
Stelara (ustekinumab) is a biologic medication that targets specific proteins involved in inflammation. Administered through injection, it has proven effective in managing symptoms and slowing the progression of various chronic inflammatory conditions.
The Cost Factor ????
Stelara is not cheap; a single dose can range between $20,000 and $30,000 annually, depending on the condition being treated. This makes Medicare’s role in covering these expenses crucial for patients.
Stelara and Medicare ????
Stelara is most often covered under Medicare Part B when administered in a healthcare setting like a doctor’s office. It can also be covered under Part D if self-administered.
Coverage Nuances ????
Under Medicare Part B, you typically pay 20% of the Medicare-approved amount after meeting the Part B deductible. If covered under Part D, the costs will depend on the specific drug plan’s formulary and tier structure.
Prior Authorization and Quantity Limits ⚠️
Your Medicare plan may require “prior authorization,” meaning your healthcare provider must demonstrate the medication’s medical necessity. Also, there may be quantity limits or other restrictions depending on your Medicare plan.
Supplemental Options ????️
A Medigap policy can help cover the additional 20% under Medicare Part B, or you might consider Medicare Advantage as an all-in-one alternative with added benefits.
Conclusion ????
Stelara has truly revolutionized treatment in its therapeutic areas, offering patients a new lease on life. Although the cost can be prohibitive, Medicare offers a viable pathway to affordability, particularly through Part B and sometimes Part D.
Understanding your Medicare coverage can be the difference between feeling overwhelmed by medical expenses and experiencing the life-changing benefits that Stelara can offer. ????
MBG IS AN INSURANCE BROKER AND IS NOT ASSOCIATED, ENDORSED, OR AUTHORIZED BY THE SOCIAL SECURITY ADMINISTRATION, THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, OR THE CENTER FOR MEDICARE AND MEDICAID
SERVICES (CMS)
